DUMMERSTON, Vt. -- While the Affordable Care Act made a bit of difference in giving more Americans access to health care, the reality remains that the United States has the worst health care system in the developed world.

This conclusion is that of the Commonwealth Fund, a private foundation that's done health care policy research for decades. You can't get a statement more damning this one, which comes from its 2014 report:

"The United States health care system is the most expensive in the world, but this report and prior editions consistently show the U.S. underperforms relative to other countries on most dimensions of performance.

"Among the 11 nations studied in this report - Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States - the U.S. ranks last, as it did in the 2010, 2007, 2006, and 2004 editions of 'Mirror, Mirror.'

"Most troubling, the U.S. fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last or near last on dimensions of access, efficiency, and equity."

The research in this report was compiled before the ACA kicked in, and when one takes a look at it, you can see why the ACA represents only a small step toward untangling a hopelessly complicated, excessively expensive, and wildly unequal U.S. health care system.

The UK, with its National Health Service, was ranked No. 1. It spent $3,495 per capita on health care, compared to $8,508 in the United States. Only New Zealand, at $3,182, spent less per capita.

Yet the UK ranked first in safety and effectiveness of care, first in access to care, second in equity (fairness), and third in timeliness of care. By comparison, the U.S. was last in equity, last in efficiency, ninth in access. and seventh in safety.

And despite all the money spent on health care in the United states - nearly 18 percent of our Gross Domestic Product (GDP) - the U.S. health care system is the most unaffordable, and the less money you have, the more likely you are to be sick. That may explain why our nation is dead last in the three indicators of healthy lives in the Commonwealth report: Mortality amenable to health care, infant mortality, and healthy life expectancy after age 60.

Curiously enough, the UK, while achieving the top mark for its heath system, ranked 10th, just above the United States on the healthy life index.

However, if you've gotten this far, you may have figured out that the 10 nations that finish ahead of the United States in the Commonwealth report all have universal health care coverage. With the exception of the Swiss, all have socialized, single-payer systems.

If you want to look at why access to health care makes a
difference, come to Vermont. According to the latest figures collected by the Centers for Disease Control and Prevention (CDC), nearly 99 percent of all Vermont children have health insurance, and 81 percent have access to medical and dental care.

Access to coverage makes a difference. Vermont has the third lowest rate of childhood obesity, at 24.5 percent, compared to nearly 40 percent in Louisiana and Mississippi.

Those numbers are so good because Vermont made a choice in 1989 to start providing health coverage to children. Vermont's Dr, Dynasaur program has been so successful, Congress used it as the model for the federal Children's Health Insurance Program.

Vermont has also worked to build partnerships between public and private institutions, as well as working hard to control costs and improve the delivery of health care. And now, we are moving toward being the first state in the country to have universal health care coverage.

Once upon a time, government existed to improve the lives of its citizens. Our nation has gotten far away from that goal, treating any plan to accomplish something good as bordering on satanic. In national politics, The truly extreme sneer at the idea of the common good.

But the numbers don't lie. The nations that are our peers do a better job caring for the health of their citizens than the United States. Their citizens live longer and healthier lives, while in this country we watch the spectacle of conservative leaders trying to outdo each other in acting with cruelty toward those in need.

While the ACA has reduced the number of the uninsured, there are still millions who lack health insurance, particularly in the states where Republican governors refuse to accept federal money to expand Medicaid. A country that spends about $3,000 more per person that any other nation in the world should be able to do better.

AR's Chief of Correspondents, Randolph T. Holhut, holds an M.P.A. from the Kennedy School of Government at Harvard University and has been an award-winning journalist in New England for more than 30 years. He edited "The George Seldes Reader" (Barricade Books). He can be reached at randyholhut@yahoo.com.